1. Welcome to the Breastfeeding Peer Counseling Program….
Session 3 1

2. Session 3
Session 3 2

3. Session 3 3

4. Activity Warm-Up “When You Counsel”
Sing the song entitled “When You
Counsel” found in your handbook
In groups, make up a new song
describing what counseling means to you
Sing your song to large group
Session 3 4

5. Review
Turn to a partner and share your experiences practicing the 3-Step Counseling Strategy
What are your questions regarding the 3-Step Counseling Strategy or other topics covered in Session 2?
Discuss what you learned from the guest speaker
Session 3

6. Preview Locate Agenda for Session 3 in handbook
Review Agenda with large group
What questions do you have about the topics to be covered in this session?
Session 3

7. Discussion Early Breastfeeding Problems
Look at the charts posted around the room
Stand next to a problem you experienced
Write on flip chart paper:
Signs and symptoms
How problem was resolved
Session 3 7

8. Sore Nipples Some nipple tenderness in beginning is not unusual
Seek help if a mother has:
Bruised,
Bleeding, or
Blistered nipples
Session 3 8

9. Causes of Sore Nipples Most common causes: Other causes: Recommend:
Poor Positioning
Poor Latch
Other causes:
Not breaking suction
Baby’s tongue
Incorrect breast pump use
Skin problems
Recommend:
Corrected positioning and/or latch will bring immediate relief
Session 3 9

10. Damaged Nipple Session 3 10
©B. Wilson-Clay/Kay Hoover, The Breastfeeding Atlas, used with permission.
Session 3 10

11. Badly Damaged Nipple Session 3 11
©B. Wilson-Clay/Kay Hoover, The Breastfeeding Atlas, used with permission.
Session 3 11

12. Refer her to a Lactation Specialist or her health care provider
Sore Nipples
Continue to breastfeed while nipples heal
Applying breastmilk will help with healing
Avoid using soaps or applying alcohol
Use different positions
If problem continues after helping...
Refer her to a Lactation Specialist or her health care provider
Session 3 12

13. Breast Shells/Nipple Shields
Breast shells: protect sore nipples
Nipple shields: help baby latch
and protect nipple
If a mother is using a nipple shield, ensure she is getting help from a lactation specialist
Session 3 13

14. Breast Fullness vs Engorgement
Happens between day 2-4
Breasts get fuller, heavier & larger
Breasts producing mature milk
Engorgement
Breasts are hard, red & painful
Mother not breastfeeding enough
Fluid and milk builds up
Session 3 14

15. “Engorged Breasts” Session 3 15
©B. Wilson-Clay/Kay Hoover, The Breastfeeding Atlas, used with permission.
Session 3 15

16. Discussion Engorgement
Look at this balloon representing an engorged breast – why would it be hard to latch onto?
In your groups, discuss what causes engorgement
Session 3 16

17. Causes of Engorgement Delayed or missed breastfeeding sessions
Incorrect positioning or latch
Restricted and/or scheduled feedings
Use of formula, water or pacifiers
Session 3 17

18. Causes of Engorgement (cont’d)
Baby feeding ineffectively
Use of IV fluids during labor
Sudden weaning
Insufficient pumping
Breast surgery
Session 3

19. Helping a Mom with Engorgement
If milk is flowing massage & apply heat before breastfeeding
If milk is not flowing apply cold compresses - SEEK HELP!
Lean breasts into bowl of warm water & massage
Apply pressure around nipple
Session 3 19

20. Helping a Mom with Engorgement (cont’d)
Hand express or pump until softer
Breastfeed often! ( times in 24 hrs)
Apply cold compresses between feedings
If baby is still having problems latching on…
Refer her to a lactation specialist
Session 3 20

21. Activity Helping a Mother with Engorgement
Divide into groups of 3
See scenarios in handbook
Use “Observers Checklist” in Worksheet Section
Each person plays role of counselor, mother and observer
Session 3 21

22. Plugged Ducts A plugged duct: Tender spot or lump in breast
Duct blocked with thick milk
Happens slowly
Milk not able to drain
Session 3 22

23. Plugged Ducts (cont’d)
Mother may feel ok - no fever
If not treated, may lead to:
Reduced milk production
Breast infection
If a mother has symptoms for more than a few days or starts to get a fever...
REFER her to a health care provider or a lactation specialist
Session 3 23

24. Causes of Plugged Ducts
Missed feedings
Bra too tight
Pulling up bra (instead of loosening it)
Using diaper bags/carriers with straps on front
Session 3 24

25. Causes of Plugged Ducts (cont’d)
Mother sleeping on stomach
Applying pressure to breast while feeding
Mother having more milk than her baby needs
Session 3

26. NEEDS to be seen by health care provider!
Mastitis
Breast infection
Occurs at anytime
Happens quickly
Feels like the flu (fever ~101º)
Breast(s) swollen, tender & red
Treated with antibiotics
NEEDS to be seen by health care provider!
Session 3 26

27. Mastitis
©B. Wilson-Clay/Kay Hoover, The Breastfeeding Atlas, used with permission.
Session 3 27

28. Mastitis (cont’d) Encourage mother to: Breastfeed often
See health care provider & follow instructions
Get plenty of rest
Drink plenty of fluids (even when not thirsty)
Session 3 28

29. Thrush Yeast infection May be passed back & forth Can occur at anytime
Early - right after birth
Later - when breastfeeding is going well
Mother should continue breastfeeding
Session 3 29

30. Thrush
©B. Wilson-Clay/Kay Hoover, The Breastfeeding Atlas, used with permission.
Session 3 30

31. Thrush
©B. Wilson-Clay/Kay Hoover, The Breastfeeding Atlas, used with permission.
Session 3 31

32. Thrush (cont’d) Health care provider will treat: Mother Baby
Mother’s partner (sometimes)
If breastfeeding hurts…
REFER her to a health care provider or a lactation specialist
Session 3 32

33. Thrush (cont’d) Encourage mother to:
Continue taking medication as prescribed, even if symptoms are gone
Use clean, cotton only, breast pads
Rinse nipples with plain water and air dry
Session 3 33

34. Thrush (cont’d) Encourage mother to:
Boil pump kit parts - 20 minutes/day
Boil pacifiers, bottle nipples & teethers for 20 minutes/day
throw away after 1 week of treatment
Session 3 34

35. Refer to health care provider!
Jaundice
Common in newborns
Caused by build up of yellow substance in blood – bilirubin
Skin and whites of eyes can become yellow
Severe jaundice can harm baby’s brain
Refer to health care provider!
Session 3 35

36. Jaundice (cont’d) Babies born with extra red blood cells
Red blood cells break down - bilirubin builds up
Colostrum has a laxative effect – encourages stooling
Session 3 36

37. Jaundice (cont’d) Becomes a problem when baby doesn’t stool enough
Baby may be sleepy & not breastfeed enough
Prevented by:
breastfeeding as soon as possible after birth
breastfeeding times per day
Session 3 37

38. Refer to a Lactation Specialist
Jaundice (cont’d)
Encourage mothers to follow advice of health care provider
American Academy of Pediatrics recommends mothers breastfeed often
If told to stop breastfeeding, talk about pumping to keep up milk supply and...
Refer to a Lactation Specialist
Session 3 38

39. Spitting Up
Session 3 39

40. Spitting Up Babies spit up for many reasons:
Strong milk-ejection reflex (let down)
Allergy to some formulas
Illness
Too much breastmilk at a feeding
Taking formula before or after breastfeeding
Strong gag reflex
Session 3 40

41. Spitting Up (cont’d) Outgrow spitting up by 4-6 months
Suggestions that may help:
Keep baby in semi-reclined position
Give baby a break if gulping or choking
Breastfeed on one side at each feeding
Recommend not giving formula
Encourage mother talk to health care provider about her diet
Session 3 41

42. REFER her to baby’s health care provider
Spitting Up (cont’d)
Gastroesophageal Reflux Disease (GERD)
Serious health problem
Babies with GERD can continue to breastfeed
Mother is worried about her baby spitting up…
REFER her to baby’s health care provider
Session 3 42

43. Slow Weight Gain Can be caused by: Not feeding often enough
Limiting length of feedings
Weak milk ejection reflex (let down)
Mother not making enough milk
Baby not able to get enough milk
Baby is sick
Session 3 43

44. Slow Weight Gain (cont’d)
Mother worried baby not gaining enough weight…
Listen to her fears
Encourage her to continue breastfeeding
Pumping can improved supply
Supplementing with formula may be needed temporarily
REFER to the baby’s health care provider or a lactation specialist
Session 3 44

45. Failure-to-Thrive Babies who: Have not regained weight by 2 wks
Are still losing weight after 7 days
Can also happen after first few weeks
Serious health problem
Followed by a health care provider & lactation specialist
Session 3 45

46. Failure-to-Thrive Possible causes: Baby’s or mother’s health problems
Not feeding often enough
Limiting length of feedings
Mother not making enough milk
Baby not able to get enough milk
Poor bonding
Session 3 46

47. Failure-to-Thrive (cont’d)
When helping a mother…
Listen to her fears and be supportive
Health care provider may suggest formula
Should be able to continue breastfeeding
Encourage discussion of her concerns with lactation specialist & baby’s health care provider
Session 3 47

48. Baby’s Refusal to Breastfeed
Baby may suddenly refuse to breastfeed
Mother may think something is wrong with her milk
Mother may have hurt feelings
Two main reasons why baby may refuse:
Bottle nipple preference
Nursing strikes
Session 3 48

49. Bottle Nipple Preference
“Nipple confusion”
Giving bottles &/or pacifiers too soon
Faster flow makes milk “easier” to get
Encourage mothers to not give bottles/ pacifiers until baby is 3-6 weeks old
Session 3 49

50. Nursing Strikes Baby suddenly refuses breast
Way of telling mother there is a problem
Rarely lasts longer than a couple days
Session 3 50

51. Nursing Strikes (cont’d)
Common causes:
Return of mother’s period or pregnancy
New soap, perfume or deodorant
Change in mother’s diet
Baby has earache, cold or other health problems
Teething
Recently separated from mother (work/school)
Refer to a lactation specialist if strike lasts
more than 24 hrs.
Session 3 51

52. Activity Counseling Mothers with Early Breastfeeding Problems
Divide into groups of 3
See scenarios in handbook
Use “Observers Checklist” in Worksheet Section
Each person plays role of counselor, mother and observer
Session 3 52

53. Medications and Herbal Remedies
Session 3 53

54. Medications and Herbal Remedies
Most medications okay
Check with HCP before taking
Talk to lactation specialist if told to stop breastfeeding
May need to “Pump and Dump”
Pseudoephedrine (Sudafed) can reduce milk supply
Session 3 54

55. Common Herbal Remedies
In some cultures used to treat illnesses
Most are not harmful
Some are very dangerous
May increase or decrease milk supply
Before she uses any herbs check with lactation specialist
Session 3 55

56. Birth Control Methods Many options for breastfeeding mothers
Choice may depend on:
Culture
Religion
Lifestyle
Talk to healthcare provider about birth control before baby is born
Choose method that will work with breastfeeding
Session 3 56

57. Non-Hormonal Methods Barrier Methods Spermicides
IUDs (intrauterine device)
Sterilization
Session 3 57

58. Non-Hormonal Methods LAM (Lactational Amenorrhea Method)
All of the following must be present:
Exclusively breastfeeding
Period has not returned
Baby less than 6 months old
Still breastfeeding at night
Session 3 58

59. Non-Hormonal Methods Natural Family Planning
No sex during certain times of month
Both partners trained & want to use method
Mother watches temperature, vaginal mucous, & number of days since last period
Classes available to learn about this method
Session 3 59

60. Not Forms of Birth Control
Rhythm method
Withdrawal
Session 3 60

61. Hormonal Methods - Progestin
Possible reduction in milk supply if:
Started before baby is six weeks old
Dose is too high
Mother does not have a good milk supply
Session 3 61

62. Hormonal Methods - Progestin
The Mini-pill
Depo-Provera
Progestin IUDs
The Morning After Pill
Session 3 62

63. Hormonal Methods - Estrogen
The Pill
The Patch
Vaginal Contraceptive Ring
DO NOT use until baby is at least 6 months old
Estrogen often reduces milk supply
Note: See PC Handbook (page 84) for this content (not found in Facilitator’s Guide).
Session 3 63

64. Activity Counseling Mothers with Concerns about Birth Control
Divide into groups of 3
See scenarios in handbook
Use “Observers Checklist” in Worksheet Section
Each person plays role of counselor, mother and observer
Session 3 64

65. Unhealthy Environments
Session 3 65

66. Cigarettes Mothers who smoke should still breastfeed their babies
Breastmilk protects babies from harm caused by nicotine & second hand smoke
Session 3 66

67. Cigarettes (cont’d) Second hand smoke may cause: Colds Ear infections
Asthma
Higher risk of Sudden
Infant Death Syndrome (SIDS)
Session 3 67

68. Cigarettes (cont’d) Encourage smoking mothers to:
Smoke after breastfeeding
Smoke outside
Change/Remove clothes
after smoking
Not smoke in bed
Quit or cut down on cigarettes
Refer her to a program if she wants to quit
Session 3 68

69. Alcohol Found in breastmilk
Equal amounts in breastmilk as in mother’s blood
More mother drinks = More baby gets
May interfere with milk ejection reflex
May make baby sleepy or suck poorly
Session 3 69

70. Alcohol (cont’d) Abuse: Can affect way mother cares for baby
May not take good care of baby
May not breastfeed often enough
Regular use/abuse can cause baby to:
Gain weight slowly
Have failure-to-thrive
Encourage treatment
Session 3 70

71. Alcohol (cont’d) No more than 1 drink per day 5 ounces of wine
12 oz of beer
1 ½ ounces of liquor
Highest level occurs one hour after having a drink
Session 3 71

72. Alcohol (cont’d) Suggestions:
Breastfeed first, then wait 2-3 hours after her drink before she breastfeeds again
If the baby gets hungry, she should give stored breastmilk
If she becomes engorged, she can pump her breasts to feel better
Session 3 72

73. Illegal Drugs Illegal drugs hurt mother & baby
Often other drugs mixed in – poisons
Mothers might get their children taken away
Mother needs to stop breastfeeding
Talk to your supervisor
Session 3 73

74. Activity Counseling Mothers Living in Unhealthy Environments
Divide into groups of 3
See scenarios in handbook
Use “Observers Checklist” in Worksheet Section
Each person plays role of counselor, mother and observer
Session 3 74

75. Closing Activity, Preview & Home Assignment
Session 3 75

76. Activity Closing Pick a Song Title
Stand by the song title that best describes how you feel
Share why you picked that song title
Session 3 76

77. Activity Closing Summarize today’s session Tree Chart
What topics were covered
Move Post-it Notes
Preview of Session 4 & Homework...
Session 3 77

78. Homework
Practice the 3-Step Strategy with your family and friends before the next session
The more you practice, the easier it will become!
Don’t forget:
Ask questions
Affirm feelings
Educate (when appropriate)
Session 3 78